This amendment updates the Alternative Benefit Plan (ABP) pages to align with recent changes to the pharmacy services benefit.

Targeted Case Management Rate Increases

behavioral health rate increase.

personal care rate increase.

authorizes increased federal financial participation (FFP) for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP under section 1905(y) of the Social Security Act.

updates the inpatient hospital reimbursement methodology for inpatient psychiatric services for individuals
under 21 admitted to Residential Rehabilitation Services for Youth (RRSY) programs certified by the New York Office of Alcoholism and Substance Abuse Services (OASAS), by adding a 5.4% statutory cost of living adjustment.

This amendment updates the state plan to waive the Recovery Audit Contractor (RAC) Program.

sets an end date of March 31, 2022, for a previously approved one and one-half percent (1.5%) across-the-board payment reduction on hospital inpatient services.

To remove the expiration date from PR SPA 21-0011 and add language to keep the Puerto Rico Local Poverty Level at 85 percent of the federal poverty level.